It has established a longstanding partnership with Beckman Coulter UK, part of one of the world’s leading diagnostics companies. Four years ago, the company became the trust’s sole supplier when haematology expertise was added to the core laboratory. This collaboration culminated recently in the opening of an integrated blood sciences unit last November. The new laboratory is one of the most advanced of its kind in Europe, offering the clinical teams faster and more accurate results through a streamlined, contamination-free testing process.
Trust and integrity
As Dr James Hooper, divisional director for laboratory medicine at the trust, said: “The relationship with Beckman Coulter is based on trust and integrity, being able to draw on our different strengths. We work together as members of a team, delivering what is most beneficial for patients. Approached in this way, it provides an excellent template for how a private-public partnership can succeed.”
The trust will benefit from having the stability of a five-year agreement, with access to new Beckman Coulter systems as they are released. The company is also making specific equipment available to the laboratory which helps to streamline services to patients. In turn, Beckman Coulter will benefit in being able to use the laboratory as a European demonstration site. As is the case with all its clients, Beckman Coulter provides an extensive after-sales support service to the laboratory, including a technical support line and regular maintenance cover. As well as the monthly call-off to check reagent levels, Beckman Coulter is able to provide a flexible supply of a specific reagent to meet changing needs.
Delivering immunoassay excellence
The Royal Brompton Hospital laboratory is classified as a small- to medium-sized facility, handling approximately 200–300 samples a day, with no GP or accident and emergency service. It provides a 24-hour service to over 100 critical care beds – out of a total of 400 beds.
However, it differs from other hospital laboratories of similar size in that it is required to provide a far wider range of tests per sample – 22 to 25 parameters compared with the more usual six to eight test parameters. “Our requirements for immunoassay excellence and breadth of menu are very specific,” Dr Hooper stressed. Alongside its range of routine immunoassay testing, the laboratory focuses on cardiac markers including CK-MB and troponin, as well as total IgE due to the need for investigation and monitoring of allergy.
The multimillion pound refurbishment of existing laboratory facilities included the installation of new, multifunctional blood specimen systems at the Royal Brompton Hospital in Chelsea, London, and also at the trust’s Harefield Hospital, the specialist heart and lung facility in Middlesex.
“We are bringing together our separate virology, immunology and bacteriology services so that they now function alongside our core chemistry and immunoassay facilities, deliberately blurring the distinction between different disciplines,” Dr Hooper explained.
“By centralising our different areas of expertise in one integrated laboratory, we are now able to measure many more individual blood components (~50) than previously. This means many more tests can be performed using fewer blood samples from patients. In addition, now that we house all sample testing equipment in one facility, delays and variations to our turnaround time have been reduced, and we can deliver a far wider range of tests during a 24-hour period.”
The laboratory had always been very successful in attracting staff at all levels who are committed to its patient care objectives. “However, the transformation of the laboratory into a combined blood services unit has also enabled the hospital to improve working conditions significantly for laboratory staff,” he explained.
“This is a very collaborative team, and we believe delivering excellence for the patient starts with good and harmonious working relationships within the laboratory, and at all levels.” Consolidating the facilities with fewer instruments has reduced capital expenditure and ongoing maintenance. Staff training was simplified, and the use of the same reagents across both laboratories has ensured greater consistency of test results.
The hospital has also streamlined the flow of test request information from the patient to the laboratory by introducing a series of electronic data transfer techniques. This starts with electronic test requesting at the bedside, with the data communicated via wireless links to the laboratory via the laboratory information system (LIS). The samples arrive in the laboratory via a high-speed pneumatic tube system, reducing waiting time for samples dispatched from the wards.
Underpinning heart and lung research work
Dr Hooper summarises the key benefits of the consolidating the laboratory facilities as:
* reducing instrumentation and maintenance costs
* providing value for money and revenue consolidation
* ensuring reagent synergy and consistency of results
* delivering improved quality control standards
* expanding overall test menu and the number of tests available 24 hours a day
* improving working conditions, with better use of space and resources
* enhancing job satisfaction, staff recruitment and retention
* ending physical and psychological barriers between disciplines.
The Royal Brompton Hospital was founded in 1841 as a charity to treat patients with tuberculosis. It established Europe’s first adult cystic fibrosis clinic 45 years ago and is now the EU’s largest treatment centre for this condition, caring for more than 1000 adults and 200 children.
Across both its hospitals, the trust treats more than 90,000 out-patients and 26,000 in-patients each year. It is Europe’s top-ranked respiratory research centre, and the cardiac, cardiovascular and critical care teams are rated in the top three of those most highly cited. Dr Hooper sees the expansion and integration of the laboratory services as vital in supporting the ongoing research into diseases and treatments.
“We already carry out research into new markers for heart care,” he explained. “And we want to use the new facilities to support new research as we begin to investigate less-common diseases, especially of the lung.”
Closed-tube sampling cuts measurement inaccuracy
Alongside two existing Coulter LH 750 haematology units, and the Remisol data management system, the company has newly installed the standalone UniCel DxC 600 clinical chemistry system and an integrated platform comprising the UniCel DxC 600i Synchron Access clinical chemistry system linked to an Access 2 immunoassay system.
The DxC 600i combines chemistry and immunoassay testing in one unit – offering a menu of 150 tests (including a cardiac panel), an onboard capacity of 89 reagents and parallel processing of samples. This is possible because an automated aliquot is taken by the sample processor and then routed to the Access immunoassay platform to improve efficiency by speeding throughput and reducing bottlenecks.
A special feature is the closed-tube sampling technology of the DxC systems. This ensures greater sample integrity as the sample cannot be contaminated by external factors. In addition, it protects laboratory staff from exposure to potential hazards. Beckman Coulter has pioneered this closed-tube technology worldwide.
“The analytical instruments of Beckman Coulter are the only ones worldwide that can analyse the blood from sample tubes without the need for decapping. The sample probe punctures the rubber top, aspirates the serum and apportions it to the test modules of the instrument,” explained Dr Hooper.
“Avoidance of decapping is a major safety improvement for staff – minimising the need to contact patients’ serum, and limiting the production of aerosols. It is also better for patients in that removing the caps can lead to inaccuracies in measurement. Closed-tube sampling prevents possible evaporation from samples.”
Beckman Coulter also provided an automated standalone sample processor, the AutoMate 800, to receive, centrifuge, aliquot and sort the blood sample tubes, thus saving time and increasing the number of tests that can be processed. Dr Hooper pointed out that it has already reduced manual processing steps by approximately 35%. For example, it is able to read the ward-generated barcode on the tube, communicate with the analytical instruments and will, if necessary, prepare subsamples (for analysis in specialised laboratories), automatically labelling the tubes and eliminating the potential risk of transcription errors. An Immage 800 was also installed for the laboratory to continue its dedicated protein analysis service.
“The Department of Laboratory Medicine has also championed many developments on the wards, such as wireless electronic requesting, with the vision of improving the overall quality of service to patients, reducing risk to patients and staff alike,” added Dr Hooper. “The combination of advances on the wards and in the laboratory is what makes the whole process state-of-the-art.”
In conclusion, Dr Hooper is confident that the laboratory’s long-term partnership with Beckman Coulter UK – to deliver and support advanced technology – not only improves patient care but also enables the laboratory to provide a more varied and challenging working environment for its staff. Taken together, these advances will ensure that the newly integrated laboratory services at the Royal Brompton & Harefield NHS Foundation Trust retain their position at the forefront of European laboratory practice, contributing at the highest level in a world-class institution.